Lack Of Insurance Cover A Major Hurdle In Care For Mentally Ill

The suicide in the city on Tuesday of Partha De, who was suffering from schizophrenia, has once again brought into focus the grim situation of patients with mental disorders in the country.

Pointing out that currently mentally ill patients do not get health insurance cover, experts said De, who had received treatment at a State-run mental hospital for a while, could possibly have led a normal life if he was provided with health insurance coverage enabling long term treatment.

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De had been the focus of intense public scrutiny about two years back for living with the remains of his dead sister and two pet dogs for six months before he was discovered.

Speaking to The Hindu, well-known psychiatrist and secretary of the Kolkata Psychiatry Club, Partha Dutt said, “Schizophrenia patients like De require a lot of care and supervision to ensure that medicines are administered regularly.” He argued that even as De was released from the State-run Pavlov Hospital after his condition “reportedly improved”, he (Mr. De) probably did not receive “adequate follow up treatment.”

The issue of mentally ill persons not getting health insurance coverage was taken up in a recent conference — The Need for Inclusion of Mental Illness under the Purview of Medical Insurance — organised by the Kolkata Psychiatry Club. Experts at the conference from the fields of psychiatry, law and the insurance sector urged the Centre to ensure quick passage of the Mental Health Care Bill (MHCB) 2016, which will make it legally binding for health insurance companies to provide coverage.

Legal experts pointed out that the Supreme Court has stated several times that the Right to Health is implied in Article 21 of the Constitution which enshrines Right to Life. “If there is a right to health, then mental health should also come under its purview. This makes health insurance coverage for mental illnesses even more necessary,” P.K. Mallik, a Supreme Court advocate, told the conference.

Inpatient care dilemma

Health practitioners pointed out that currently there is no coverage provided by health insurance companies to mentally ill patients as they do not always require “admission” to a hospital, which is a key stipulation for health insurance coverage. Most mentally ill persons require counselling and other outpatient treatment, they said.

The reasoning was corroborated by Sanjay Datta of ICICI Lombard, a major health insurance provider. Mr Datta told The Hindu, “We are unable to provide health insurance coverage to mentally ill patients because they mostly require outpatient treatment (treatment without getting hospitalised) such as counselling but currently our schemes are for inpatient treatment. There are also no clear guidelines for diagnosis of mental disorders.”

“There is a need to streamline the process of diagnosis of mental disorders, which along with high prices of related medicines and social stigma involved, is responsible for the absence of health insurance coverage,” said Debasish Sanyal, Professor of Psychiatry at the KPC Medical College and Hospital in the city.

Bangalore-based psychiatrist Sudipto Chatterjee argued that “unavailability of data” regarding mental illness is one of the key obstacles in providing insurance coverage.

Inadequate resources

The Mental Health Care Bill (MHCB) 2016 was passed in the Rajya Sabha in August last year but is yet to be passed in the Lok Sabha. The Bill clearly states: “Every insurer shall make provision for medical insurance for treatment of mental illness on the same basis as is available for treatment of physical illness.”

According to the World Health Organisation (WHO) in terms of mental disorders, India contributes to 11.6% of the global burden of disease. WHO’s Mental Health Atlas (2011) paints a grim picture of the mental healthcare infrastructure in the country. It states that the number of mental hospitals in the country is just 43 which is grossly inadequate given the number of patients.

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